- Enrollment id
- O20160719001784
- Enrollment state
- OK
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1306203187
- Multiple npi flag
- N
- Ccn
- 371717
- Associate id
- 6709796436
- Organization name
- MCALESTER REGIONAL HEALTH CENTER AUTHORITY
- Doing business as name
- SOUTHEAST HOSPICE
- Organization type structure
- OTHER
- Organization other type text
- PUBLIC TRUST
- Proprietary nonprofit
- N
- Address line 1
- 901 E VAN BUREN AVE
- City
- MCALESTER
- State
- OK
- Zip code
- 745014239